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Critical genes as early warning signs: example of vinyl chloride.

We have analysed liver angiosarcomas from individuals having been occupationally exposed to vinyl chloride (VC) to identify, in cancer-related genes, lesions which could be VC-specific. Two genetic alterations have been identified: the first one is a GGC --> GAT (Gly --> Asp, Asp13p21) mutation at codon 13 in the Ki-ras gene, found in five out of six tumors. The second one is an AT --> TA transversion in the p53 gene resulting in missense mutations at different codons and was found in three out of six tumors. By analysing both the tumors and sera from the same patients, we have shown that the Asp13p21 and mutant p53 proteins could be detected reliably in the serum. We thereafter analysed 225 serum samples, selected from a cohort of about 900 VC-exposed workers, for the presence of the two mutant proteins and p53 antibodies. A statistical analysis supports a strong dose-response relationship between the serum markers positivity and the VC-exposure. A follow-up of this cohort should now allow us to assert the predictive value of these markers.

Aged↗

Early warning.

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Animals↗

The El Niño Southern Oscillation and the historic malaria epidemics on the Indian subcontinent and Sri Lanka: an early warning system for future epidemics?

The recurrent great malaria epidemics which occurred in the Punjab province of former British India and Ceylon before the introduction of residual insecticides have been related to excessive and failing monsoon rains respectively. In the arid Punjab, rainfall facilitated breeding and increased the lifespan of the mosquito vector and, in the wet part of Ceylon, failing monsoon rains caused rivers to pool, creating more favourable breeding conditions. The periodic fluctuations in monsoon rainfall and epidemic malaria are here explained in relation to the El Niño Southern Oscillation. In the Punjab, epidemic malaria between 1868 and 1943 correlates significantly (r = 0.34, P < 0.005) with the sea surface temperature anomalies in the Eastern Equatorial Pacific, a parameter of the oscillation, and epidemics were significantly more prevalent in a year with a wet monsoon following a dry El Niño year than in other years. In Ceylon, epidemics were significantly more prevalent during El Niño years, when the same south-west monsoon tends to fail. With the reduced reliance on residual insecticides and the recurrence of epidemic malaria on the Indian subcontinent, advances made in predicting El Niño events may be used to forecast high and low risk years for future malaria epidemics.

Disease Outbreaks↗

Sales of over-the-counter remedies as an early warning system for winter bed crises.

OBJECTIVES: To evaluate the pattern of emergency adult medical admissions during the winter period and the usefulness of sales of over-the-counter cough/cold remedies as a predictor of these. METHODS: The databases of a single NHS trust acute unit and pharmacy outlets in its catchment area were analyzed retrospectively, comparing numbers of emergency admissions, ICD-10 discharge codes, local electronic point-of-sale (EPOS) and national sales data. RESULTS: Over nine consecutive winter periods from 1992/3, peak admissions always occurred within a defined ten-day period from 29th December to 9th January. Emergency admissions increased significantly during this period (P = 0.0002). Pharmaceutical/retail data were available for three consecutive winters 1998/99, 1999/2000 and 2000/2001, none of which coincided with increased influenza activity nationally. Acute respiratory illness as defined by International Classification of Diseases, 10th edition (ICD-10) discharge coding did not appear to contribute to the increase in admissions at the peak. However, National and Local EPOS sales were positively correlated with admissions and the rate of EPOS sales exceeded an empiric threshold of 1000 units per week two weeks prior to the admissions peak in each year. CONCLUSIONS: Emergency admissions over the winter period are increasing and can be expected within a period of only ten days each year. No firm relationship between acute respiratory illness and admissions could be defined but local EPOS data may give up to two weeks warning of the peak in admissions and merits further prospective evaluation.

Antitussive Agents↗

Increased facial temperature as an early warning in Sudden Infant Death Syndrome.

The promotion of supine sleeping position in young infants has resulted in significant declines in the incidence of Sudden Infant Death Syndrome although little is understood in terms of mechanisms. We hypothesize that supine sleeping position promotes appropriate thermal regulation via the face and head which is the major source of infant heat loss. By facilitating temperature regulation, the supine position ensures that the centre for thermoregulation in the hypothalamus does not become dysfunctional due to local temperature fluctuations. Because these hypothalamic, thermoregulatory neurones are synaptically linked to those regulating respiration in the medulla, adequate temperature control by the infant maintains normal respiration. In contrast, an increase in face and head temperature over and above core temperature would suggest thermoregulatory stress and an increased likelihood of respiratory apnoea.

Body Temperature Regulation↗

The emergence of potent forms of methamphetamine in Sydney, Australia: a case study of the IDRS as a strategic early warning system.

A striking finding of the Illicit Drug Reporting System (IDRS) in recent years has concerned the emergence in Sydney of a number of different forms of potent methamphetamine. This paper demonstrates the operation of the IDRS in detecting and documenting an increase in both the availability and use of these forms of methamphetamine in Sydney, and Australia more widely, since 1998. Data from different components of the IDRS are utilized to propose that there are currently at least three forms of methamphetamine available in Sydney that are considered by the market to be distinct commodities: methamphetamine powder ('speed'), base methamphetamine ('base') and crystalline methamphetamine ('ice'/'shabu'/'crystal meth'). Base and ice are more potent forms of methamphetamine than speed, and international experience, along with preliminary data obtained from the IDRS, suggest that their use is associated with harms in a number of domains.

Adolescent↗

Reflections on the development and implementation of an early warning system for ecstasy and related drug markets in Australia.

Regular and systematic monitoring of drug markets provides the basis for evidence-based policy. In Australia, trends in ecstasy and related drug (ERD) markets have been monitored in selected jurisdictions since 2000 and nationally since 2003, by the Party Drugs Initiative (PDI). The PDI maximises the validity of conclusions by triangulating information from (a) interviews with regular ecstasy users (REU), (b) interviews with key experts and (c) indicator data. There is currently no other system in Australia for monitoring these markets systematically; however, the value of the PDI has been constrained by the quality of available data. Difficulties in recruiting and interviewing appropriate consumers (REU) and key experts have been experienced, but largely overcome. Limitations of available indicator data from both health and law enforcement continue to present challenges and there remains considerable scope for enhancing existing routine data collection systems, to facilitate monitoring of ERD markets. With an expanding market for ecstasy and related drugs in Australia, and in the context of indicator data that continue to be limited in scope and detail, there is a strong argument for the continued collection of annual, comparable data from a sentinel group of REU, such as those recruited for the PDI.

Australia↗